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[Page: H12857] GPO's PDF---
Mr. BLILEY. Mr. Speaker, I ask unanimous consent to take from the Speaker's table the Senate bill (S. 580) to amend title IX of the Public Health Service Act to revise and extend the Agency for Healthcare Policy and Research, and ask for its immediate consideration in the House.
The Clerk read the title of the Senate bill.
The SPEAKER pro tempore. Is there objection to the request of the gentleman from Virginia?
Mr. BROWN of Ohio. Mr. Speaker, reserving the right to object, I yield to the gentleman from Virginia (Mr. BLILEY) for an explanation of his unanimous consent request.
Mr. BLILEY. Mr. Speaker, I thank the gentleman from Ohio for yielding to me.
Mr. Speaker, S. 580 reauthorizes and renames the Agency for Healthcare Policy and Research as the agency for Health Research and Quality, AHRQ. It also refocuses the Agency's mission, which is to conduct and support research on the quality, outcomes, cost, and utilization of healthcare services, and access to those services.
The agency will promote quality by sharing information, build public-private partnerships to advance and share quality measures, report annually to Congress on the state of quality in the Nation, support the evaluation of state-of-the-art information systems for healthcare quality, support primary care and access in underserved areas, facilitate innovation in patient care with streamlined assessment of new technologies, coordinate quality improvement efforts to avoid duplication, and facilitate utilization of preventative health services.
The bill also authorizes appropriations for pediatric graduate medical education in children's hospitals. These represent important reforms.
Mr. Speaker, I urge my colleagues to support this request.
Mr. BROWN of Ohio. Mr. Speaker, further reserving my right to object, with that explanation, I want to associate myself with the remarks of the gentleman from Virginia (Mr. BLILEY) to let my colleagues know that I support the adoption of S. 580.
I am particularly pleased because one of the key provisions in this bill is the Graduate Medical Education Funding for children's hospitals. They will receive actual dollars in fiscal year 2000 if this authorization is enacted. We have worked in a bipartisan manner in this bill, and I am glad to see its inclusion.
HCPR is needed to study key health care issues as we go into the next century. These issues include access, cost, quality, and equity in virtually all aspects of the health care system.
The true bipartisanship exhibited by the gentleman from Virginia (Mr. BLILEY), the gentleman from Florida (Mr. BILIRAKIS), his staff, the Senate, particularly the efforts of Senators JEFFORDS, FRIST, KENNEDY, and their staff, especially the efforts of Ellie Dehoney in my office.
Mr. Speaker, I recommend that this bill be adopted by unanimous consent in the House of Representatives.
Mr. BILIRAKIS. Mr. Speaker, I am pleased to support consideration of S. 580, the Healthcare Research and Quality Act of 1999 by the House today. I introduced H.R. 2506 in the House on September 14, 1999. Following approval by my Subcommittee and the full Commerce Committee, the House voted overwhelmingly to pass H.R. 2506 on September 28, 1999.
Late last week, the Senate passed S. 580 by unanimous consent. The bill before us today represents a bipartisan agreement between the House and Senate authorizing committees on a compromise version of the bills previously approved by each body. This widely supported, bipartisan measure is critical to improving the quality of health care in this country. The ``Healthcare Research and Quality Act of 1999'' will significantly increase health care research and science-based evidence to improve the quality of patient care.
S. 580 reauthorizes the Agency for Health Care Policy and Research (AHCPR) for fiscal years 2000-2005, renames it as the ``Agency for Healthcare Research and Quality,'' and refocuses the agency's mission to become a focal point, and partner to the private sector, in supporting of health care research and quality improvement activities.
Equally important, the bill authorizes critical funding for our nation's children's hospitals. I was pleased to support the adoption of these provisions when this bill was previously considered by the House. Passage of this legislation today is an important step in ensuring that America's children's hospitals receive the resources that they need.
Mr. BROWN of Ohio. Mr. Speaker, I withdraw my reservation of objection.
The SPEAKER pro tempore. Is there objection to the request of the gentleman from Virginia?
There was no objection.
The Clerk read the Senate bill, as follows:
Be it enacted by the Senate and House of Representa tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Healthcare Research and Quality Act of 1999''.
SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
(a) IN GENERAL.--Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) is amended to read as follows:
``TITLE IX--AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
``SEC. 901. MISSION AND DUTIES.
``(a) IN GENERAL.--There is established within the Public Health Service an agency to be known as the Agency for Healthcare Research and Quality, which shall be headed by a director appointed by the Secretary. The Secretary shall carry out this title acting through the Director.
``(b) MISSION.--The purpose of the Agency is to enhance the quality, appropriateness, and effectiveness of health services, and access to such services, through the establishment of a broad base of scientific research and through the promotion of improvements in clinical and health system practices, including the prevention of diseases and other health conditions. The Agency shall promote health care quality improvement by conducting and supporting--
``(1) research that develops and presents scientific evidence regarding all aspects of health care, including--
``(A) the development and assessment of methods for enhancing patient participation in their own care and for facilitating shared patient-physician decision-making;
``(B) the outcomes, effectiveness, and cost-effectiveness of health care practices, including preventive measures and long-term care;
``(C) existing and innovative technologies;
``(D) the costs and utilization of, and access to health care;
``(E) the ways in which health care services are organized, delivered, and financed and the interaction and impact of these factors on the quality of patient care;
``(F) methods for measuring quality and strategies for improving quality; and
``(G) ways in which patients, consumers, purchasers, and practitioners acquire new information about best practices and health benefits, the determinants and impact of their use of this information;
``(2) the synthesis and dissemination of available scientific evidence for use by patients, consumers, practitioners, providers, purchasers, policy makers, and educators; and
``(3) initiatives to advance private and public efforts to improve health care quality.
``(c) REQUIREMENTS WITH RESPECT TO RURAL AND INNER-CITY AREAS AND PRIORITY POPULATIONS.--
``(1) RESEARCH, EVALUATIONS AND DEMONSTRATION PROJECTS.--In carrying out this title, the Director shall conduct and support research and evaluations, and support demonstration projects, with respect to--
``(A) the delivery of health care in inner-city areas, and in rural areas (including frontier areas); and
``(B) health care for priority populations, which shall include--
``(i) low-income groups;
``(ii) minority groups;
``(iii) women;
``(iv) children;
``(v) the elderly; and
``(vi) individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care.
``(2) PROCESS TO ENSURE APPROPRIATE RESEARCH.--The Director shall establish a process to ensure that the requirements of paragraph (1) are reflected in the overall portfolio of research conducted and supported by the Agency.
``(3) OFFICE OF PRIORITY POPULATIONS.--The Director shall establish an Office of Priority Populations to assist in carrying out the requirements of paragraph (1).
``SEC. 902. GENERAL AUTHORITIES.
``(a) IN GENERAL.--In carrying out section 901(b), the Director shall conduct and support research, evaluations, and training, support demonstration projects, research networks, and multi-disciplinary centers, provide technical assistance, and disseminate information on health care and on systems for the delivery of such care, including activities with respect to--
``(1) the quality, effectiveness, efficiency, appropriateness and value of health care services;
``(2) quality measurement and improvement;
``(3) the outcomes, cost, cost-effectiveness, and use of health care services and access to such services;
``(4) clinical practice, including primary care and practice-oriented research;
``(5) health care technologies, facilities, and equipment;
``(6) health care costs, productivity, organization, and market forces;
``(7) health promotion and disease prevention, including clinical preventive services;
``(8) health statistics, surveys, database development, and epidemiology; and
``(9) medical liability.
``(b) HEALTH SERVICES TRAINING GRANTS.--
``(1) IN GENERAL.--The Director may provide training grants in the field of health services research related to activities authorized under subsection (a), to include pre- and post-doctoral fellowships and training programs, young investigator awards, and other programs and activities as appropriate. In carrying out this subsection, the Director shall make use of funds made available under section 487(d)(3) as well as other appropriated funds.
``(2) REQUIREMENTS.--In developing priorities for the allocation of training funds under this subsection, the Director shall take into consideration shortages in the number of trained researchers who are addressing health care issues for the priority populations identified in section 901(c)(1)(B) and in addition, shall take into consideration indications of long-term commitment, amongst applicants for training funds, to addressing health care needs of the priority populations.
``(c) MULTIDISCIPLINARY CENTERS.--The Director may provide financial assistance to assist in meeting the costs of planning and establishing new centers, and operating existing and new centers, for multidisciplinary health services research, demonstration projects, evaluations, training, and policy analysis with respect to the matters referred to in subsection (a).
``(d) RELATION TO CERTAIN AUTHORITIES REGARDING SOCIAL SECURITY.--Activities authorized in this section shall be appropriately coordinated with experiments, demonstration projects, and other related activities authorized by the Social Security Act and the Social Security Amendments of 1967. Activities under subsection (a)(2) of this section that affect the programs under titles XVIII, XIX and XXI of the Social Security Act shall be carried out consistent with section 1142 of such Act.
``(e) DISCLAIMER.--The Agency shall not mandate national standards of clinical practice or quality health care standards. Recommendations resulting from projects funded and published by the Agency shall include a corresponding disclaimer.
``(f) RULE OF CONSTRUCTION.--Nothing in this section shall be construed to imply that the Agency's role is to mandate a national standard or specific approach to quality measurement and reporting. In research and quality improvement activities, the Agency shall consider a wide range of choices, providers, health care delivery systems, and individual preferences.
``(g) ANNUAL REPORT.--Beginning with fiscal year 2003, the Director shall annually submit to the Congress a report regarding prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations.
``SEC. 911. HEALTH CARE OUTCOME IMPROVEMENT RESEARCH.
``(a) EVIDENCE RATING SYSTEMS.--In collaboration with experts from the public and private sector, the Agency shall identify and disseminate methods or systems to assess health care research results, particularly methods or systems to rate the strength of the scientific evidence underlying health care practice, recommendations in the research literature, and technology assessments. The Agency shall make methods or systems for evidence rating widely available. Agency publications containing health care recommendations shall indicate the level of substantiating evidence using such methods or systems.
``(b) HEALTH CARE IMPROVEMENT RESEARCH CENTERS AND PROVIDER-BASED RESEARCH NETWORKS.--
``(1) IN GENERAL.--In order to address the full continuum of care and outcomes research, to link research to practice improvement, and to speed the dissemination of research findings to community practice settings, the Agency shall employ research strategies and mechanisms that will link research directly with clinical practice in geographically diverse locations throughout the United States, including--
``(A) health care improvement research centers that combine demonstrated multidisciplinary expertise in outcomes or quality improvement research with linkages to relevant sites of care;
``(B) provider-based research networks, including plan, facility, or delivery system sites of care (especially primary care), that can evaluate outcomes and evaluate and promote quality improvement; and
``(C) other innovative mechanisms or strategies to link research with clinical practice.
``(2) REQUIREMENTS.--The Director is authorized to establish the requirements for entities applying for grants under this subsection.
``SEC. 912. PRIVATE-PUBLIC PARTNERSHIPS TO IMPROVE ORGANIZATION AND DELIVERY.
``(a) SUPPORT FOR EFFORTS TO DEVELOP INFORMATION ON QUALITY.--
``(1) SCIENTIFIC AND TECHNICAL SUPPORT.--In its role as the principal agency for health care research and quality, the Agency may provide scientific and technical support for private and public efforts to improve health care quality, including the activities of accrediting organizations.
``(2) ROLE OF THE AGENCY.--With respect to paragraph (1), the role of the Agency shall include--
``(A) the identification and assessment of methods for the evaluation of the health of--
``(i) enrollees in health plans by type of plan, provider, and provider arrangements; and
[Page: H12859] GPO's PDF
``(ii) other populations, including those receiving long-term care services;
``(B) the ongoing development, testing, and dissemination of quality measures, including measures of health and functional outcomes;
``(C) the compilation and dissemination of health care quality measures developed in the private and public sector;
``(D) assistance in the development of improved health care information systems;
``(E) the development of survey tools for the purpose of measuring participant and beneficiary assessments of their health care; and
``(F) identifying and disseminating information on mechanisms for the integration of information on quality into purchaser and consumer decision-making processes.
``(b) CENTERS FOR EDUCATION AND RESEARCH ON THERAPEUTICS.--
``(1) IN GENERAL.--The Secretary, acting through the Director and in consultation with the Commissioner of Food and Drugs, shall establish a program for the purpose of making one or more grants for the establishment and operation of one or more centers to carry out the activities specified in paragraph (2).
``(2) REQUIRED ACTIVITIES.--The activities referred to in this paragraph are the following:
``(A) The conduct of state-of-the-art research for the following purposes:
``(i) To increase awareness of--
``(I) new uses of drugs, biological products, and devices;
``(II) ways to improve the effective use of drugs, biological products, and devices; and
``(III) risks of new uses and risks of combinations of drugs and biological products.
``(ii) To provide objective clinical information to the following individuals and entities:
``(I) Health care practitioners and other providers of health care goods or services.
``(II) Pharmacists, pharmacy benefit managers and purchasers.
``(III) Health maintenance organizations and other managed health care organizations.
``(IV) Health care insurers and governmental agencies.
``(V) Patients and consumers.
``(iii) To improve the quality of health care while reducing the cost of health care through--
``(I) an increase in the appropriate use of drugs, biological products, or devices; and
``(II) the prevention of adverse effects of drugs, biological products, and devices and the consequences of such effects, such as unnecessary hospitalizations.
``(B) The conduct of research on the comparative effectiveness, cost-effectiveness, and safety of drugs, biological products, and devices.
``(C) Such other activities as the Secretary determines to be appropriate, except that a grant may not be expended to assist the Secretary in the review of new drugs, biological products, and devices.
``(c) REDUCING ERRORS IN MEDICINE.--The Director shall conduct and support research and build private-public partnerships to--
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